Contact For Providers Helping you care for your patients. Most PDF readers are a free download. With more than 35 years of experience, we help make it easier for health plans to improve and connect member and provider journeys. Make your mental health a priority. If you donotget prior approval via the prior authorization process for services and drugs on our prior authorization lists: When and how should prior authorization requests be submitted? Learn more, Attachments is an online tool in the Availity Provider Portal that allows you to submit electronic predetermination of benefits requests handled by Blue Cross and Blue Shield of Illinois (BCBSIL). This tool is an enhancement to our Radiology Quality Initiative (RQI) program, which AIM administers for BCBSIL. Most PDF readers are a free download. (Note: SeeMedicaid pagefor BCCHP and MMAI Provider Finder links.) Get the security you need from the company you trust. Learn more, The Availity Reporting On-Demand application allows users to readily view, download, save and/or print the Provider Claim Summary (PCS) and other reports online, at no additional cost. This new site may be offered by a vendor or an independent third party. Our trusted community experts can give you the one-on-one help you need to shop for health insurance. Sign Up or Log In Member Returning Shopper Employer Producer User Name: Password: New User? There, you can log in to access your member benefits and services. You'll see details that may help lower health care costs. CDT codes, descriptions and data copyright 2022 American Dental Association. A prior authorization isnota guarantee of benefits or payment. We provide dental claim and network administration services for Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas, as well as . Talk to a health plan consultant: 833-828-6962 (TTY: 711) Mon-Fri, 8 a.m. to 8 p.m. ET/CT, 7 a.m. to 7 p.m. MT/PT New member? Step 2If prior authorization is required, have the following information ready: Step 3 Submit Your Prior Authorization Request. Log in to your account to access your health plan information: Provider Enrollment Enroll as a Blue Cross provider, update provider information, or begin the credentialing/recredentialing process. The Electronic Refund Management (eRM) tool is designed to help simplify overpayment reconciliation and related processes. Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. We look forward to working with you to provide quality services to our members. Blue Cross and Blue Shield of Illinois (BCBSIL) is committed to promoting health and wellness of its members and communities through accessible, cost-effective, quality health care. Sign up for theLifeTimes newsletterto get health and benefits articles delivered to your inbox every month. Note: Most out-of-network services require utilization management review. Register Log In Benefits and Eligibility Provider Enrollment. The size and strength of our provider and physician networks allow your clients to get the most value out of their BCBSIL coverage. Prior authorization requests for our Blue Cross Medicare Advantage (PPO)SM(MA PPO), Blue Cross Community Health PlansSM(BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SMmembers can be submitted to eviCore in two ways. My150. You can: Make Payments Pay a bill online or sign up for auto bill pay. Learn about coverage changes. This version of Internet Explorer is out of date. Pharmacy and Prescription Plan Information, What You Should Know About Dispensing Limits, Find an in-network doctor, hospital or other provider, Review benefits, account balances, claims status and more, Order or print a replacement member ID card, Choose how youd like to get your BCBSIL communications. Espaol. Welcome to DNoA Connect, a provider self-service tool where dental offices can conveniently connect to patient information for members serviced by Dental Network of America (DNoA). Visit bcbs.com or call 800-810-2583 to find network providers. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. Learn more, The AvailityPatient ID Finder tool allows providers to obtain the BCBSIL patient ID number and group number by entering patient-specificdate elements. Certain kinds of care require precertification. BCBS of Illinois is the PPO network for all Marketplace Plans (except the OHC Plan) and all Non-Marketplace Plans. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. Start a New Application or Retrieve a Saved Application. Step 1 Confirm if Prior Authorization is Required. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. Learn more, The Patient Care Summary tool uses claim-based information to provide you with a consolidated view of a patient's health care history at the point of care. Blue Cross Blue Shield of Illinois is committed to providing the best resources for health care providers. Once a prior authorization request is received and processed, the decision is communicated to the provider. Simply select Get a Quote and you can view and compare our plans and pricing. For government programs prior authorization requests handled by eviCore healthcare (eviCore): Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). appeal requests for specific clinical claim denials through the Availity Portal. Blue Cross and Blue Shield of Illinois 300 East Randolph Street Chicago, Illinois 60601-5099. . File is in portable document format (PDF). Applicable FARS/DFARS apply. In addition, some sites may require you to agree to their terms of use and privacy policy. View Drug Lists Log in to Your Account You can reach us at 1-800-786-7930. X. One X. How to Enroll You must first enroll in Medicare Part A and Part B before joining a Medigap (Medicare Supplement) plan. Sign up! See More Forms Find the forms and resources you need to do business with us. In addition, some sites may require you to agree to their terms of use and privacy policy. If you have questions on a request handled by AIM or eviCore, call the appropriate vendor, as noted above. Control Health Care Costs You can view coverage details, health and wellness information, check claim status and access member ID card information. One option is Adobe Reader which has a built-in screen reader. Learn more, CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of thepharmacy PA program. Learn more about BCBSIL and what we offer today. Simply select Get a Quote and you can view and compare our plans and pricing. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association ( Note: See Medicaid page for BCCHP and MMAI Provider Finder links.) To return to our website, simply close the new window. We help ensure health plan members receive quality, affordable specialty care, like chemotherapy and orthopedic surgery, that's driven by rigorous clinical evidence. Request a new replacement member ID card, or download a temporary copy. Contact your local Blue Cross Blue Shield company for help choosing a Medigap (Medicare Supplement) plan and getting enrolled. Provider Toolbox Easy-to-use tools and resources for your practice. * You can use C3 to help determine how coding combinations on a particular claim may be evaluated during the adjudication process. The Dispute tool allows providers to electronically submit appeal requests for specific clinical claim denials through the Availity Portal. In general, there are three steps providers should follow. Blue Cross and Blue Shield of Illinois. If you have questions on a request handled by BCBSIL, contact our Medical Management department. Learn more Availity Authorizations View and compare our plans and pricing now by getting a quote. File is in portable document format (PDF). Please note: Some of the tools may require registration through a third party vendor portal; and some tools may not be available for government programs at this time. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. . Footer Skip to footer content. Already Registered? Join here. One option is Adobe Reader which has a built-in reader. FEP Service. Please attempt your login request again after clicking the appropriate sign-on link below. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. Learn more, OptiNet is an online assessment tool developed by American Imaging Management (AIM) to collect modality-specific data from imaging providers. Log in to your account to get the most accurate, personalized search results based on your plan. Search for doctors, dentists, hospitals and other health care providers. If a member doesn't use a Med-Select hospital, they must pay the Part A deductible. Use these SmartERSM Care options instead of the emergency room. Learn more, Clear Claim Connection (C3) is a free online reference tool that mirrors the logic behind BCBSIL's code-auditing software. Standard Policies <link rel="stylesheet" href="styles.b444f5b04a590bc057e9.css"> Our Medicare Advantage plans (HMO and PPO) offer all of the coverage of Original Medicare, plus other benefits. You can: Pay a bill online or sign up for auto bill pay. Featured News News Release | July 13, 2023 HCSC Transforms Prior Authorization Process You can save quotes for later or apply now. TeamCare's provider web resources are designed to help you find what you need fast, so you can focus on providing care to our members. New to Blue Access for Members? Most PDF readers are a free download. Log in to Blue Access for MembersSM (BAMSM) If you have any questions, call the number on the member's ID card. Pick the best payment option for your Blue Cross and Blue Shield of Illinois (BCBSIL) monthly bill. BCBSIL offers two options for Medicare Supplement coverage our Standard and Med-Select plans. Saved Quotes Returning Shopper Finding the right health insurance is easy! To view this file, you may need to install a PDF reader program. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Stay informed about BCBSIL programs, products, initiatives, and more. General Inquiries. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Sometimes, a plan may require the member to request prior authorization for services. One option is Adobe Reader which has a built-in reader. To view this file, you may need to install a PDF reader program. ( Note: See Medicaid page for BCCHP and MMAI Provider Finder links.) Out-of-Area BlueCard PPO Providers: 800-810-BLUE (2583) Additional Contact Information; Pharmacy Program: 800-423-1973: . You have choices for where you get non-emergency care. Subscribe now to receive the monthly Blue Review via email. Learn more. Your health plan may allow you to get care from a Blue Cross and Blue Shield affiliated doctor or hospital while youre away from home. Explore Medical Benefits. Find an in-network doctor, hospital or other provider To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. To view this file, you may need to install a PDF reader program. Webinars Altruista Health GuidingCare is a web-based care management tool for providers to monitor rendered services, activates, quality measures and care plans for Illinois Blue Cross Community Health PlansSM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. Our vice president and chief medical officer, Derek Robinson, offers insights on timely topics, using a peer-to-peer approach. Register now Learn about the many ways we are contributing to the well-being of our local Illinois communities in the latest Corporate Social Responsibility Report. In addition, some sites may require you to agree to their terms of use and privacy policy. Utilization management review requirements and recommendations are in place to help ensure our members get the right care, at the right time, in the right setting. Your local company can help you to: Change your coverage Estimate the cost of a medical procedure File or check on claim Replace your member ID card Review your balance View your plan details Looking for Insurance? PDF File is in portable document format (PDF). 1-312-653-6000. Blue Cross and Blue Shield of Illinois makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them. Forms and Manuals Access key information for participating in our network. Most PDF readers are a free download. Originally published 10/23/2014; Revised 2015-2023. . Don't have a User ID? Learn More. To get started, register for a web account or log into your existing account using the options below. Copyright document.write(new Date().getFullYear()); Health Care Service Corporation. Insurance Basics. Provider Finder Search for doctors, dentists, hospitals and other health care providers. Closing Gaps in Care for Group Medicare Advantage Members, What to Include When Emailing Our Provider Network Consultant Team, Any Provider Accepting Medicare Can See Flex Plan Members, Earn CME/CEU Credit at Free Depression Webinar, Reminder: 2022 Claim Editing Enhancements, Updated: CMS Payment Adjustments for Medicare and MMAI Providers During Public Health Emergency, Delivering Quality Care: Supporting Healthy Hearts, Free Heart Health Month and Black History Month Events at Blue Door Neighborhood Center, New Laboratory Management Program To Begin on May 1, 2022, BCBSIL Needs Your Help To Update Your Telehealth Information, Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2022 Part 1, New Mail Order Service Provider for Pharmacy Members, New Specialty Pharmacy for Pharmacy Members, Updated: Prior Authorization for Interfacility Transfers Waived Until Feb. 28, 2022, Updated: Surprise Billing Provisions of No Surprises Act, Reminder: 2022 Claim Editing Enhancements Register for a Training Webinar, Pharmacy Program Updates: Quarterly Pharmacy Changes You can save quotes for later or apply now. View and compare our plans and pricing now by getting a quote. We are also the largest provider of health benefits in Illinois, serving more than 8.9 million members in all 102 counties across the state. The site may also contain non-Medicare related information. The pages in this section are designed to follow the claim cycle - from the moment a BCBSIL member walks into your office, through . In addition, some sites may require you to agree to their terms of use and privacy policy. Learn more, Home A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Learn more, Find facilities recognized for expertise in bariatric surgery, cardiac care, cancer care, cellular immunotherapy, knee and hip replacement, maternity, spine surgery, and transplants on the Blue Distinction website. This version of Internet Explorer is out of date. All rights reserved. Review care locations Visit their website to find one today. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. We know your time is valuable. Register Now Step-by-Step Guide for Provider Finder. This new site may be offered by a vendor or an independent third party. Refer to important information for our linking policy. BCBS.com makes finding an in-network provider easy. Refer to important information for our linking policy. It will open in a new window. External link You are leaving this website/app (site). External link You are leaving this website/app (site). Understand your care options ahead of time so you can save time and money. Learn more, Clinical Quality Validation (CQV) is a web-based application in the Availity Provider Portal that allows providers to quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS) measures. Access now with your Connect Community - BCBSIL user name. This new site may be offered by a vendor or an independent third party. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members. Availity is a trademark of Availity, LLC., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Blue Cross and Blue Shield of Illinois. View our provider manual for claims processing and operational information and information about provider networks and programs. Sign in now with your Connect Community - Blue Cross and Blue Shield of Illinois user name. Blue Cross Blue Shield of Illinois. Blue Cross and Blue Shield of Illinois (BCBSIL) offers Blue Cross Community Health Plans SM (BCCHP SM) which includes a network of independently contracted providers including physicians, hospitals, skilled nursing facilities, ancillary providers, Long-term Services and Support (LTSS) and other health care providers through which Illinois Medica. Legal and Privacy eviCore healthcare (eviCore) is an independent company that has contracted with BCBSIL to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. All rights reserved. But first, we'll need some information to direct you to your local Blue Cross Blue Shield provider. Policies & Guidelines Review Blue Cross and Blue Advantage medical and pharmacy policies or comment on draft policies. To obtain fast, efficient, detailed benefits information for Blue Cross and Blue Shield members, you can use Availity's Eligibility and Benefits tool. One option is Adobe Reader which has a built-in reader. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Claims and Eligibility. Blue Cross and Blue Shield of Illinois is proud to be the states only statewide, customer-owned health insurer. Forgot Username Forgot Password. Create an account. In addition to verifying membership/coverage status and other important details,this step returns information on prior authorization requirements and utilization management vendors, if applicable.

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